ABSTRACT
OBJECTIVE: To compare three screening tests for cervical neoplasia. METHOD: Women (6301) were screened simultaneously with cytology, cervicography and the acetic acid test (AAT). Biopsies were taken from the acetowhite lesions and every fifth seemingly normal cervix. Positive cases (both at screening and histology) were referred for colposcopy. The histology results served as the golden standard. RESULTS: Cytology was positive in 1.7% of cases, cervicography in 10.7% and the AAT in 17.8%. The sensitivity of cytology was 19.3%, of cervicography 41.8% and the AAT 49.4%. Corresponding specificities were 99.3%, 78.8% and 48.5%. In 23% of biopsies showing cervical intraepithelial neoplasia (grade I--III), all three screening tests were negative. By combining the three tests, a sensitivity of 76.9% was achieved. CONCLUSION: The sensitivity of cytology alone is not great enough for implementing as a screening test in a developing country where screening programs are often inadequate. Screening with a combination of tests, once or a few times per woman's life, is a more acceptable alternative since it allows for less screening events without sacrifying sensitivity.
Subject(s)
Mass Screening/methods , Photography , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/pathology , Vaginal Smears/methods , Acetates/analysis , Adult , Aged , Biopsy, Needle , Developing Countries , Female , Humans , Incidence , Middle Aged , Predictive Value of Tests , Reagent Kits, Diagnostic , Sensitivity and Specificity , South Africa/epidemiologyABSTRACT
OBJECTIVE: To compare the specificity of speculoscopy and the acetic acid test (AAT). METHODS: A randomized controlled trial was performed on 1150 women in a primary healthcare clinic. The main end-points were the sensitivity and specificity of speculoscopy and the AAT. RESULTS: The mean age of the patients was 37.7 years in the speculoscopy group (n=545) and 37.5 years in the AAT group (n=605). Cervicography (the golden standard) was positive in 11.3% of the participants, speculoscopy in 20.4% and the AAT in 25.1%. The sensitivity, specificity and the kappa value for speculoscopy were 53.5%, 83.6% and 0.23, respectively. For the AAT, the corresponding figures were 51.1%, 77.3% and 0.15. No statistically significant differences were found between these two groups. Of clinical importance, however, was a finding that speculoscopy did not miss a single case of high grade squamous intra-epithelial lesion or cancer whilst the AAT missed five such lesions. CONCLUSION: Speculoscopy could not be shown to have an improved specificity when compared with the acetic acid test. The low specificity of both the tests will result in the referral of too many patients for colposcopy.
Subject(s)
Acetic Acid , Colposcopy/methods , Uterine Cervical Neoplasms/pathology , Adult , Aged , Female , Humans , Indicators and Reagents , Middle Aged , Sensitivity and Specificity , South Africa , Vaginal Smears/methodsABSTRACT
OBJECTIVE: To evaluate cytology as a screening method for cervical neoplasia in pregnancy and to compare it with cervicography and the acetic acid test (AAT). METHODS: In a large antenatal clinic in South Africa, 842 women were screened utilizing cytology, cervicography and the acetic acid test simultaneously. The proportion of positive results of the different tests were compared and the agreement calculated by the kappa statistic. RESULTS: The mean age of the women was 27 years, and 12.5% smoked. Cytological smears were abnormal (low-grade squamous intra-epithelial lesion and higher degrees of abnormality) in 1.4% of cases, cervicography in 6.3% and the AAT in 14.3% (P = 0.5400). Kappa values were as follows: cytology vs. cervicography 0.01, cytology vs. AAT 0.0 and cervicography vs. AAT 0.2. CONCLUSIONS: As a result of cytology's rather low yield and the small measure of agreement between the tests, cytology should be supplemented by an additional screening test in pregnancy.
Subject(s)
Mass Screening/methods , Pregnancy Complications, Neoplastic/pathology , Uterine Cervical Dysplasia/pathology , Uterine Cervical Neoplasms/pathology , Vaginal Smears , Adolescent , Adult , Colposcopy , Evaluation Studies as Topic , Female , Humans , Infant, Newborn , Maternal Health Services , Pregnancy , Pregnancy Complications, Neoplastic/prevention & control , Sensitivity and Specificity , South Africa , Uterine Cervical Neoplasms/prevention & controlABSTRACT
OBJECTIVE: To evaluate the effect of 5% acetic acid on the cells and cellular content of cervical smears. STUDY DESIGN: A randomized, controlled trial was performed with 42 patients in each group. The study group received acetic acid application to the cervix followed by a smear, while the sequence was reversed in the control group. Cytologic evaluation of the smears was done without knowledge of the group allocation in each case. RESULTS: The group in which acetic acid was applied before the smear was taken showed significantly poorer staining properties of the smear (P < .0001) and also significantly lower cellular content (P = .0006). CONCLUSION: Acetic acid has adverse effects on the cervical smear and should be applied after the smear is taken.
Subject(s)
Acetic Acid/pharmacology , Vaginal Smears/methods , Adult , Female , Humans , Single-Blind Method , Uterine Cervical Neoplasms/pathology , Uterine Cervical Dysplasia/pathologyABSTRACT
From 1 January 1980 to 31 December 1985, 81 maternal deaths occurred at Pelonomi Hospital, Bloemfontein; these were classified as direct obstetric-related (74 cases), indirect obstetric-related (6) and non-obstetric (1). The overall maternal mortality rate was 2.87 per 1000 deliveries, including deaths related to abortion and ectopic pregnancy, but excluding the non-obstetric death. Among booked patients the maternal mortality rate was 0.32 and among unbooked patients 11.13 per 1000 deliveries. The maternal mortality rate for patients from the Bloemfontein area was 0.72 per 1000. Puerperal sepsis and postabortal sepsis accounted for 45.7% of the deaths. Avoidable factors were considered to be present in 65 cases (80.2%).
